The Role of Positive Affect in Enhancing Extinction Learning and Exposure Therapy for Anxiety Disorders

Zbozinek, Tomislav D.; Craske, Michelle G.

doi:10.5127/jep.052615

Cited by 44 publications

(39 citation statements)

References 145 publications

(269 reference statements)

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“…Inductions that increase the positive valence of CSs during extinction/exposure reduced reinstatement in laboratory and analogue samples [63,64] and lessened rapid reacquisition in a laboratory sample [65]. As positive affect enhances encoding, rehearsal, and retrieval of information, and relating incoming information to already-known information positive mood may augment the formation of inhibitory associations as well as their retrieval over time and context [66]. Methods for inducing positive affect at the moment that individuals with clinically severe anxiety approach feared situations are yet to be evaluated.…”

Section: (Ii) Positive Affectmentioning

confidence: 99%

State-of-the-art and future directions for extinction as a translational model for fear and anxiety

Craske

Hermans

Vervliet

2018

Phil. Trans. R. Soc. B

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246

244

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Through advances in both basic and clinical scientific research, Pavlovian fear conditioning and extinction have become an exemplary translational model for understanding and treating anxiety disorders. Discoveries in associative and neurobiological mechanisms underlying extinction have informed techniques for optimizing exposure therapy that enhance the formation of inhibitory associations and their consolidation and retrieval over time and context. Strategies that enhance formation include maximizing prediction-error correction by violating expectancies, deepened extinction, occasional reinforced extinction, attentional control and removal of safety signals/behaviours. Strategies that enhance consolidation include pharmacological agonists of NMDA (i.e. d-cycloserine) and mental rehearsal. Strategies that enhance retrieval include multiple contexts, retrieval cues, and pharmacological blockade of contextual encoding. Stimulus variability and positive affect are posited to influence the formation and the retrieval of inhibitory associations. Inhibitory regulation through affect labelling is considered a complement to extinction. The translational value of extinction will be increased by more investigation of elements central to extinction itself, such as extinction generalization, and interactions with other learning processes, such as instrumental avoidance reward learning, and with other clinically relevant cognitive-emotional processes, such as self-efficacy, threat appraisal and emotion regulation, will add translational value. Moreover, framing fear extinction and related processes within a developmental context will increase their clinical relevance.This article is part of a discussion meeting issue 'Of mice and mental health: facilitating dialogue between basic and clinical neuroscientists'.

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Section: (Ii) Positive Affectmentioning

confidence: 99%

State-of-the-art and future directions for extinction as a translational model for fear and anxiety

Craske

Hermans

Vervliet

2018

Phil. Trans. R. Soc. B

Self Cite

246

244

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“…Positive affect may help to tackle some of the challenges faced in the treatment of pain patients. First and most importantly, positive affect may enhance learning processes, leading to faster and more profound extinction of pain-related fear [ 87 ••]. Second, positive affect might fuel positive cognitions such as positive expectations regarding treatment outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Interventions enhancing positive affect have been shown to reduce pain and improve the well-being of pain patients [e.g., 18 •, 19 ]. Moreover, it has been suggested that enhancing positive affect may have the potential to optimize treatment efficacy of existing pain treatments [ 87 ••]. Comprehensive understanding of both risk and resilience factors for pain on processes involved in pain and in the treatment of pain might lead to most effective combined strategies in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

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Can positive affect attenuate (persistent) pain? State of the art and clinical implications

et al. 2017

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Purpose of ReviewPain is an intense experience that can place a heavy burden on peoples’ lives. The identification of psychosocial risk factors led to the development of effective pain treatments. However, effect sizes are modest. Accumulating evidence suggests that enhancing protective factors might also impact on (well-being despite) pain. Recent findings on positive affect (interventions) towards pain-related outcomes will be reviewed, and new avenues for treatment of persistent pain will be discussed.Recent FindingsPositive affect significantly attenuates the experience of pain in healthy and clinical populations. Positive affect interventions effectively reduce pain sensitivity and bolster well-being despite pain. Through both psychological and (neuro-)biological pathways, but also through its effect on central treatment processes such as inhibitory learning, positive affect can optimize the efficacy of existing treatments.SummaryComprehensive understanding of the unique roles and dynamic interplay of positive and negative affect in moderating pain may optimize the treatment of (persistent) pain.

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“…Given their importance, much research effort has been expended on understanding how such evaluations are acquired and can be altered. This reflects a wide range of intentions—from a desire to enable individuals to realize their full potential by not avoiding events or situations that hold no realistic danger (e.g., Zbozinek & Craske, ) to the intent to render certain products more desirable to boost sales (e.g., Tsiotsou, Alexandris, & Cornwell, ). Much of this research has utilized learning paradigms based on Pavlovian learning, such as in evaluative conditioning or fear conditioning.…”

Section: Introductionmentioning

confidence: 99%

Evaluative conditioning affects the subsequent acquisition of differential fear conditioning as indexed by electrodermal responding and stimulus evaluations

2019

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It is currently unclear whether the acquisition of negative stimulus valence in evaluative and fear conditioning paradigms is interrelated or independent. The present study used a transfer paradigm to address this question. Three groups of participants were trained in a picture‐picture evaluative conditioning paradigm before completing acquisition of differential fear conditioning using graphical shapes as conditional stimuli (CSs). In group congruent, the shape used as CS+ (paired with the US during fear conditioning) was paired with negative pictures, whereas the shape used as CS− (presented alone during fear conditioning) was paired with positive pictures. In group incongruent, the shape used as CS+ was paired with positive pictures, whereas the shape used as CS− was paired with negative pictures. In group different, different shapes were employed in evaluative and fear conditioning. Acquisition of differential electrodermal responses emerged within fewer acquisition trials in groups congruent and different than in group incongruent. Transfer of evaluative learning across paradigms was evident only after removal of participants who failed to display evaluative conditioning. The current research indicates that stimulus valence acquired during evaluative conditioning transfers to fear conditioning and will differentially affect the acquisition of fear learning as indexed by subjective evaluations and electrodermal responses. The findings suggest that evaluative and fear conditioning are not independent.

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The Role of Positive Affect in Enhancing Extinction Learning and Exposure Therapy for Anxiety Disorders

Cited by 44 publications

References 145 publications

State-of-the-art and future directions for extinction as a translational model for fear and anxiety

State-of-the-art and future directions for extinction as a translational model for fear and anxiety

Can positive affect attenuate (persistent) pain? State of the art and clinical implications

Evaluative conditioning affects the subsequent acquisition of differential fear conditioning as indexed by electrodermal responding and stimulus evaluations

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